This invention relates, generally, to implementation of a type of medical computer and machine related method program.
The methodology facilitates a flow of the information to maintain absolute communication in two main ways:
1) Communication between clinical staff and business staff, including their patients. 2) Communication between providers of healthcare.
The following is a tabulation of some prior art that presently appears relevant;
U.S. Pat. Nos. 3,566,365, 4,591,974 simply show renditions from hand held “superbill” implements. Sixteen other patents mention “superbill” implements without present invention's novelty, including U.S. Pat. No. 5,519,607. Clearly patentability is further evidenced in plurality of prior art. U.S. Pat. No. 5,915,241 prior art limitations include a design with reference to relative value units RVU, an actuarial operation opposed to an objective design as in present art to rule out fee outcomes, further this prior art is essentially a design for alternative (medical) practices, opposed to an standardized, acceptable AMA CPT codes. AMA CPT is essentially irrelevant to “alternative” practices and cannot precisely equate in terms of service code and coding or billing code practice. U.S. Pat. No. 5,809,476 emphasis is in reference to a British system, and primarily on ICD, diagnosis coding, “generalized” terms which can be misread or equated to universal standard information and without corresponding an ICD with CPT procedure. Present art is equating to acceptable standardized terms and descriptions. Aforesaid prior art limitations are foreclosed by “correcting” or “supplementing” the “original information”. Present invention equates to acceptable terms of AMA CPT or relative to coded data base stored to make uniform billing code practices. U.S. Pat. No. 5,325,293 limitations include change code in terms of “RUV”, reimbursement and actuarial billing codes. The said art uses “raw” or standard “correlating CPT codes”, appears unlike U.S. Pat. Nos. 5,915,241 and 5,809,476. This said art emphasis is on CPT, and foreclosed limitation on ICD codes. Any listed ICD are not an emphasis on the particular sequence or order of priority. As stated, the first ICD diagnosis is given priority in billing code process and it can delay or cause inaccurate billing codes processed. U.S. Pat. Nos. 6,192,345; 7,676,386; 7,650,291; 7,739,123; 7,613,610; 7,610,192; 7,520,419; 7,233,938; 7,410,955; 6,915,254; 6,850,889; 6,820,093; 6,192,345; 5,483,443; Prior art in latter cases mainly on “extraction”, actuarial, and evidence of other limitations stated.
Comprehensive computer implementations or other related applications may show the handling of electronic H.C.F.A submissions. Others may show a way to hide, encode, encrypt or “privacy” design, security and other features. Whereas, this invention's art is providing a means for compatibility providing such other computers, devices and machine implementation thereof. As described herein this invention is to become essentially a tool or instrument, and it serves a function combined with external implementation related packages. Wherein other implementations might very well have implements designed for security, electronic components to process heath care records and “privacy” and things. This invention may rely upon others when serving roles external programs offer, this invention becomes compatible to those programs, and it becomes obviated not to need such other purported superior designs in this invention's application. The idea of Skype®, for instance, as becoming part of this implementation of this present invention was discussed herein. The idea of Skype to implement what might be their purported technology to use their application out of their native implementation method application as a part of another's application method or implementation related program (native or web based), by highlighted phone numbers and their “Click To Call” is a belief of inventor, and his present invention, to have been an implementation Skype had made ex post facto to present invention's art. Wherein, an application, as Skype's, may become utilized on other sites, e-mail and applications like web sites, to have highlighted telephonic numbers Skype subsequently promoted as a feature of their application. Skype® started showing up on Yahoo! ® web sites and other e-mail applications. After this present invention's various documentation and development continued. Most recent history shows Facebook® as joined to add Skype in a manner purported by this inventive technology reported herein and documentation supporting present invention's as believed to have been first to have a click (or touch) and say phone number to call the (patient) from the appointment book implementation described as a part of present invention's art. Although Skype owns a certain application about their “call” and their “instant message” operation or system, the description as a specifications being part of this invention had been believed to have been already documented, including U.S. Copyrights Office. Again, other voice-over-internet-provider and e-mail systems or providers can be part of this inventive appointment book's design. As stated in present inventions aforesaid referenced “Provisional” submitted work. Since, “claims”, according to inventor's reading of U.S. Patent instructions, generally are not to be actually stated as such in “Provisional” submitted material. Disclaimer(s), by contrast, have been submitted in invention's Provisional as to that technology. When such technology is not a part of such implements becoming used out of another known electronic or software, implementation and machine method related application. It is claimed in this inventions art, described in present inventor's “Provisional” application, and it was stated in a disclaimer with this specific reference as to what is now claimed versus what was disclaimed and in what way(s). Whereas, this was and it is now articulated in these documentations and others related to present invention art.
Prior art show a plurality of “extraction” methods, systems, schemes and processes using only artificial intelligence, machine readable to review medical records to generate billing codes. This has become essentially the latest ways to present superior art to virtually solve some of the related problems this present invention has solved in actually easier ways. A problem is that machine or artificial intelligence cannot be superior to human intelligence in this billing practice. These variables will be shown distinguishing prior art from this present invention in many superior ways.
Prior art demonstrates other limitations. The information of Current Procedural Terminology (C.P.T billing codes), International Classification of Disease (I.C.D, diagnosis codes) and/or H.C.P.C.S (supply) codes is part-and-parcel set of information to the typical billing process. It is more than data information, since it requires human diagnosis. This data cannot be separated concerning the patient's billing code system. Accurate CPT is needed along there with accurate ICD, and accurate matching thereby is significant. Likewise, the human element of medical diagnosis cannot be negated. The physician and particular patient's treatment, that is, service render therewith the particular primary diagnosis used to delivery said accuracy for the true form of billing records. The machine and the other billers and coders are without first-hand knowledge.
Prior art negates either I.C.D in “extraction” or the “extraction” of C.P.T medical records needed to effectuate this accuracy of this match. The proper primary diagnosis cannot be a factor determined by machine, coders and billers. Since, it is actually human intelligence that provides the needed statements as with reference to primary, secondary, tertiary, quandary diagnosis list, the sequential order, ranking operation, or the hierarchy in this data set specification. When information becomes extracted, the sequential order is not produced once leaving the treating provider's hands. A diagnosis may become inadvertently given a secondary when it should be a primary diagnosis, if stated, intentionally changed automatically by designed machines or other coders and billers.
Therefore, prior art limitations result when all these components are not taken into account, left out of the logic or equation, including the critical element of the human intelligence and human knowledge base. Prior art's data bases cannot reproduce this retroactively or otherwise be predictive of this “face-to-face” human input part of the billing code process.
Present art is designed to be non-transitory machine readable and human intelligence is required. These components are all in present invention's art, CPT, ICD, HCPCS and other billing codes needed to be precisely matched. Also, the present invention has a method to produce an artificial intelligence with a machine and human stored readable database. Present invention enables users to create code letters which are utilized to equate with code numbers, which in turn equate with code descriptions, which further becomes set in computer readable storage and enabling the this data to be extracted from in medical records in this process. Extraction machines can readily be used to read code letters entered by physician's artificial intelligence data base and (his or her) human knowledge base. Although, the novelty hereof this invention's super biller is essentially the instrument as s method in this process, and extraction may be still become used by other implementations in prior art. To make prior art's limitations whole, where identified as discussed in the following prior art references reviewed. Virtual diagnosis code selections are replaced by actual selections in the present invention's art. Likewise, virtual service codes become validated by actual provider's account of events in treatment, after review of machine or other billers and coders change records and medium. It is more than pushing a button or a click. However, some things are just inescapable in the arena of health care quality assurance.
Prior art is essentially actuarial in context. Prior art is essentially geared as a means for producing an outcome which may favor either the most or least reimbursement depending on the known type user. Opposed to a method of the current art having accuracy with reference to the actual account of input from treating providers with reference to medical knowledge and the proper first-hand knowledge including the actual goods and service rendered and each the actual listed corresponding sequence thereof primary, secondary, tertiary, quaternary diagnosis(es). Present art thereby further enabling a method, for the user uncertain about reimbursement billing codes, to use their own customizable in-house code letters and not primarily based upon computing maximizing or minimizing reimbursement. In the alternative, present art's superior design benefits those ordinarily skilled in the art in light of changing codes causing confusion and delayed healthcare benefits.
Prior art limitations also noted are deviations from standardized and acceptable practices by American Medical Association, the body that created C.P.T, and what A.M.A calls certain “cleaned up” versions of I.C.D and HCPCS to correspond thereto. Again, history will show that prior art compromised essentially by the use of actuary algorithms, billing codes logic that work for the pool of patients. Opposed to the present invention that uses each particular patient's actual treatment and/or services rendered and face-to-face encounters in a relatively real time operation.
The present art takes values of face-to-face encounters rather than prior art that essentially uses actuarial billing code generation in terms on monetary interests alone.
The present inventions can be distinguished from prior art by allowing provider select customized in-house customizable code letters that they create, with human and computer stored readable databases. This design helps providers avoid pre-selection criteria in prior art limitations and the selection of or generation of incorrect billing code accounts. Code letters that can become dictated into medical records and extracted by means that may become part of the improvement prior art, to make prior art superior.
The ultimate superior art would take into account the following; the significance of the actual face-to-face patient encounter information of each diagnosis (ICD) to be listed in a sequential order by the significance of priority ranking and the actuary importance, typically an ascending order, with ICD listed as primary, secondary, tertiary, quandary; such ICD to become matched to each and every particular CPT service on a superior instrument or superior Superbill; include a means for extracting medical related data by human and by machine both, CPT and ICD both; include typically up to four (4) fields for ICD given in standard practices by convention as prescribed by the Health Care Finance Administration (H.C.F.A) standardized implementation forms and process by design, a body known to have the acceptable instrument used to properly submit billing codes; computer storable data base of ICD and CPT history; means to account for medical and actuarial significance to review the billing codes created before and after submissions, to change ICD and/or CPT; a means to account for actual and virtual service and/or supply codes (CPT and HCPCS codes), by systematic mechanical intelligence along therewith by human knowledge and intelligence both; means to utilize primarily reproducible, uniform, with acceptable the A.M.A's C.P.T billing codes and coding practices; means to provide objective and subjective billing and coding practices for each particular patient encounter on a given date of service, reflecting the actual care rendered in the date of service proximal to the actual date, in retrospective reviews by any given subsequent billers and coders; method to help take relatively un-skilled providers and those users that find themselves having less than ordinary skill in the art out from the loop by a system or operation that allows a subjective place holder code, a transitional code, until the relatively skilled people, and their computers, may produce accurate billing codes and their opinions from retroactive reviews of physician's orders and medical records and/or implementations; by contrast, means to help skilled providers, billers, coders, a neutral code, a subjective, generic code, and transitional code which could be implemented until specific accurate codes are presented, until updates that need to arrive or until staff needs to become updated by the learning curve of new changes in billing code material (errors and omissions avoided by selection of outdated billing codes); by contrast to above also means to help maintain treating providers in-the-loop (computer and human loop created billing code scheme) by allowing a subjective place holder code (code letters) until machines and staff become updated; a neutral code that can become the Olympian acceptable and convertible to acceptable standardized coding and billing practices in the international arena (European's and American Medical Association codes).
Medical and surgical procedures are billed using uniform practices and codes to assure that similar procedures are billed or coded consistently from procedure to procedure. Various other providers including, facilities, hospitals, physician-to-physician, allied medical related providers, and providers of insurance or healthcare payers rely on a given data set to communicate goods and services provided to patients. These instances of services, procedures, supplies, evaluation and management codes are identified by The American Medical Association's® Current Procedural Terminology (by acronym hereafter as, “C.P.T”). C.P.T is essentially a standardized system of five-digit code numbers and descriptive terms used to accurately report the medical services and procedures performed by these healthcare providers. C.P.T was developed and the system is essentially updated and published annually. C.P.T is changed periodically by the American Medical Association (hereafter, A.M.A®). C.P.T codes are vital to communicate to providers, patients, and payers the procedures performed during a medical encounter. Accurate CPT coding is crucial for proper reimbursement from payers and compliance with government regulations. Other codes are used referred to as Healthcare Common Procedure Coding System (H.C.P.C.S, pronounced as “hick picks”) codes and Center for Medicare Service (C.M.S) codes.
A second component to the aforementioned accuracy is a requirement to properly assign an International Classification of Disease commonly called, “I.C.D” (hereafter as, “I.C.D.”). For all intents and purposes this I.C.D code is the most important data component to the data set to correspond to certain C.P.T as mentioned above. Needless to say, a “diagnosis” is the cornerstone thereto rendering any coded provider healthcare.
For all practical purposes, and the scope of this disclosure, I.C.D diagnosis codes are akin to another component of codes used and developed by The A.M.A®. To help translate or to help justify said C.P.T or related goods and services performed.
Methods of Coding
Procedural coding for a physician can be done by various methods. One way is coding from the patient's records by billing-office personnel. Therefore, by human intelligence these business and administrative people (non-health practitioners) take a stab at converting medical records into billing codes. These people also take a stab at making determinations about the providers' primary diagnosis codes from the records. This method maintains consistency of coding and also helps in keeping records current. An alternative is for the physicians to do their own coding, or for a designated physician to do the coding for all physicians in an organization. This has the advantage of the physician's insight and expertise. However, due to time constraints, it is often difficult for the physician to keep current with the charting responsibilities and changes in coding practice or code numbers. This is compounded by the absolute need to match C.P.T with I.C.D in some process before patient records can be accurately submitted. Regardless of the coding option chosen or process to submit vital patient records, all these cases are involving multiple codes, CPT procedures, ICD diagnosis codes and this process essentially rests and should rely upon the physician's expertise when code assignments of claims are made to other in this healthcare system of communication.
Therefore, when there is an inferior process for communication between required C.P.T and I.C.D codes then causes a broken system or miscommunication about vital data set. The superior art of this invention is to control the mismatch from being passed along in a process of communication as mentioned above to various providers that relay upon this data set to examine the statements or claims made therein claims process medical computer programs or by any manual means to examine the same data set in records at any point such information is transmitted to another person or entity.
Many codes are incompatible and cannot be billed for the same encounter. This invention has a mechanism to flag and to block certain double/duplicate billing or coding practices. To help avoid delays from inadvertent codes that is billed together. For example, this invention features a system to alert user/providers when two so called Evaluation & Management (E&M) C.P.T related code are stated on the same date of service. A coding practice that is not generally acceptable. Although, this is a feature of this invention, the superior art of this invention demonstrates novelty in additional ways. The superior art and method is more specifically described in disclosures of this invention. Problems like provider “unbundling” and the practice of provider “bundling” are coding business practices that bring heated debates in an otherwise standard system with reference to the use of C.P.T combinations.
Some claims are delayed from questionable coding practices effectuated by “unbundling” the billing code for certain A.M.A® C.P.T codes. “Unbundling” occurs when a medical or surgical service, procedure, evaluation and management is said by some to be described by a single CPT code and it becomes broken down by providers into purported components, and a bill is then submitted for each component and/or several related components instead of the C.P.T which describes the total code. A problem exists where different allied resources purport other coding practices that differ from The Authoritative Source, The American Medical Association's Original Article, like The United States Constitution, A.M.A describes the intended C.P.T, as it represents their “C.P.T” invention.
Not with standing, there is an extremely component to C.P.T, it is called the I.C.D or diagnosis codes intended to directly correlate to and to correspond to particular C.P.T. Otherwise, the process to prepare and submit patient's records breaks down. Irrespective of other aforesaid mentioned C.T.P people coding in a process assisted by computer programs or not. Therefore, a key component is the way ICD relates to each CPT code.
It is common practice for providers to use such codes to bill patients and other payers such as insurance companies on a common uniform billing form called a Health Care Financing Administration form (HCFA form) sometimes called a Health Insurance Claim Form. A HCFA form typically requires-C.P.T related codes to become matched to I.C.D related codes. The HCFA format has a standardized format in several ways. Accordingly, any discrepancy, incomplete data point and data set, or mismatch identified could cause delay in this claim process. For example, it is more accurate to submit a HCFA claim that represents that a C.P.T procedure for taking “X-Rays” is represented by a corresponding I.C.D diagnosis code that relates to a finding typically viewed on X-Rays, such as bone. By contrast to any healthcare provider submitting a HCFA claim wherein the I.C.D diagnosis code represents a soft tissue condition. Generally, soft tissue conditions are not viewed by standard radiographs or an “X-Ray” C.P.T procedural service code for the technical (to take X-Rays) or professional (to read X-Rays) components of this billing and coding process.
Clearly there is a need for the reviewing process to have a programmatic method or process to create a mechanism to allow a distinct match for each C.P.T with each I.C.D code. Moreover, some payers will require that I.C.D diagnosis codes be listed in a sequential order of importance. For example, the first I.C.D diagnosis code is generally the most important corresponding I.C.D to match up with each C.P.T service or procedure or evaluation and management code. The second I.C.D listed is next important, third next important I.C.D and forth I.C.D last important, respectively. Importance is how closely the I.C.D relates to the C.P.T and in some cases the first I.C.D is the only one that payers look at-in the process. This emphasizes the importance that the first I.C.D be the most accurate one to avoid delays in the process of claim submissions. Currently these decisions are made by people that are simply attempting to second guess what diagnosis the practicing provider licensed to make the diagnosis considered the most important one (primary or first significant) to justify the particular C.P.T code.
Clearly, there is a need for a process including a method and implementation in order to command communication in this process to assist treating providers.
Accordingly, there are basically three broad steps which can be implemented in the handling of medical related data, coding, billing and processing. 1) The “Superbill”. Generally this consists of a hardcopy check off list of C.P.T code numbers and descriptions abbreviated one a single page. There is essentially no particular direct matching process or other system about this document. A mismatch of C.P.T and or H.C.P.C. therewith I.C.D code numbers remains left to human error. Often this page is handed to other administrative staff to determine ways to submit this data that provider may have completed on this format. Computer generated models essentially re-create the same model and the resultant is the same sorts of mismatching and other errors with code existing numbers. 2) The “H.C.F.A Form”. This is a standardized billing format form developed to list information including C.P.T and I.C.D data. Past history will show that this form has been submitted more regularly by way of handwritten entries. The necessity to submit this form in electronic format and by computer in more recent times has been implemented. This form sorts out C.P.T and I.C.D in order to list a C.P.T and or H.C.P.C. to correspond to typically one of four (4) I.C.D codes. However, a drawback is that this form is recreated in an ex post facto sort of manner. Staff without first-hand or direct knowledge must make attempts to match up C.P.T with I.C.D, and they furthermore take a stab at attempting to make a first-hand determination exactly what diagnosis or I.C.D codes the provider's most important or “number one” diagnosis (representative by an I.C.D code) to list in priority, then number two, number three and number four (least relative importance). Whereas, this C.P.T and or H.C.P.C. to I.C.D matching method in the process is a key component. to make particular C.P.T and or H.C.P.C. correspond to I.C.D. In addition, it becomes necessary to list I.C.D assigned to each particular C.P.T in particular order as well. Any mismatch creates disorganization, havoc, and even life changing events to happen. Further aggravating this problem becomes evident when there are changes in healthcare practices, to code practices and staff that are not yet trained to up dated changes. Even when staff is intact, another event that causes chaos from small medical staff practices to hospitals, to other facilities, to very large healthcare organization and other providers of healthcare governmental regulators thereof. 3) Other Elaborate Computer Software Models. Although elaborate models have been used in practice, their drawback continues to be omissions of a system that demonstrates design implementation to create a match system for C.P.T and or H.C.P.C. therewith I.C.D. Again, a mismatch remains left to human error akin to afore said mentioned methods in disclosures. In fact, even providers with elaborate disclosed computerized implementation, related methods and systems, defer this process going back a (hardcopy) “Super Bill” method. Even with elaborate software related packages another drawback becomes the fact that code changes and staff changes. In such events, providers are left with a so-called “learning curve”. Nonetheless, there needs to become a more superior “interim” method. The implement of this invention provides a superior method to re-create different codes that match code(s) typically used by a particular provider to describe the same goods and services. Whereas, certain components of this invention's code provides the same elements necessary for providers to function the same, even when changes take place around them. Elaborate database models can be up dated. However, this invention's model remains intact, even when it may become uncertain what changes in the code might become implemented in updated database. For example, providers using this application continue to virtually be using same codes, as the provider has become accustomed to learn and to use in practice to describe ones goods and services provided.
The so-called “Super bill” is an archaic method. Medical software related programs have been designed in very elaborate and variety of ways on the high-speed-internet highway. Not with standing, people using theses sophisticated programs continue to use the hard copy or even an electronic rendition or version of a “Super bill” in this aforementioned process to submit to payers. The Super bill method in this process is essentially a check off list. There is not a one-for-one matching process for each C.P.T and or H.C.P.C. checked and each I.C.D. checked on the paper form or even disclosures in computerized renditions of the same. In fact, some reviewers may actually discard one or the other codes. Without being absolutely certain heretofore with a reliable method and process that the more important code(s) set was not used, even discarded, in matching before claims are submitted to payers. The superior art allows this cross check and communication process using a method by the invention this embodiment created to be relatively certain. Billing and coding people play a role in the process. Regardless the various Methods of billing and coding people participating in various roles as discussed in the section herein. Medical providers need this reliable process, since licensed medical providers are legally known to be ultimately responsible for submitted claims in this process. Licensed medical providers make the diagnosis, and they cannot be second-guessed as to what diagnosis is more important than another diagnosis. This is an inextricable process that requires exact matches.
Moreover, codes change. This presents an even greater draw back to a process designed for billing and coding practices. This is most evident from unknowns about the test of so called “National Health Care” changes healthcare providers and the public at large shall be experiencing. When codes change there is confusion about accurate code numbers. The process faces yet other hurtles. This underscoring the need for a method in this process that will be superior over the art and standard billing or coding practices. This emphasizes the superior method of this embodiment in helping to execute the coding and the billing process that this invention demonstrates.
A five number code system is one difficult to remember. Given the fact there are literally thousands of C.P.T and I.C.D code numbers. One can recall many, until the system or process changes. This causes another delay in the delivery of healthcare goods and services, procedures, evaluation and management or C.P.T codes by numbers. Disclosures identify typical five number (or longer) codes, and some are even mixed in complicated ways with abstract letters or modifiers in the case of C.P.T codes and even I.C.D. codes.
Therefore, there is a significant need for a relatively affordable, light weight, faster and more adaptable to change type of implementation which shall greatly improve and promote communication among health care providers, treating providers, their staff, patients and others in a world of other busy life styles and domains.